Request a Callback

If you have symptoms of an urgent nature, please call your doctor or go to the nearest emergency room immediately.

After completing the form, a representative from the Penn Medicine Contact Center will contact you within one business day to facilitate scheduling an appointment or help you access our services. For even faster assistance, please call 800-789-7366 (PENN).

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Personal Information

First Name*

Last Name*

Date of Birth*

Contact Information

Daytime Phone*

Email*

Zip Code

Appointment Request

Preferred Physician or Location

Reason for Request*

NOTE: With this form, you are submitting a request for a callback so that we can help you schedule an appointment or access our services. We will contact you between 8:30 am and 7 pm. Thank you.

Psychiatry/Behavioral Health

For appointments with Penn Behavioral Health, please do not use this form. Call the Penn Behavioral Health Contact Center directly at 866-301-4PBH.